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Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Long-term outcomes of endoscopic transpapillary gallbladder drainage using a novel spiral plastic stent in acute
Junya Sato1, Kazunari Nakahara2, Yosuke Michikawa1
1Department of Gastroenterology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan.
Insights
Endoscopic transpapillary gallbladder stenting (EGBS) using a novel stent is safe and effective for acute calculus cholecystitis. It serves as a viable bridge to surgery or an alternative for patients with contraindications.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Acute calculus cholecystitis often requires surgery, but contraindications exist.
- Long-term outcomes of endoscopic transpapillary gallbladder stenting (EGBS) are not well-established.
- This study evaluates EGBS as a bridge or alternative to surgery.
Approach:
- Retrospective review of 49 patients undergoing EGBS with a novel spiral plastic stent (2011-2019).
- Evaluation of clinical success, adverse events, and long-term outcomes.
- Comparison between patients who underwent subsequent cholecystectomy and those managed non-surgically.
Key Points:
- EGBS achieved a 97% clinical success rate.
- In the surgery group (n=25), one late adverse event occurred.
- In the follow-up group (n=24), 8 late adverse events were noted, including cholecystitis recurrence and stent-related issues.
Conclusions:
- EGBS with a novel spiral stent is safe and effective for managing acute calculus cholecystitis long-term.
- EGBS can serve as a bridge to surgery or a surgical alternative for patients with contraindications.
- This approach offers a valuable option for select patients with acute calculus cholecystitis.
Background:
Endoscopic transpapillary gallbladder stenting (EGBS) is considered for patients with contraindications to early surgery for acute calculus cholecystitis. However, evidence regarding the long-term outcomes of EGBS is insufficient to date. The aim of the study was to evaluate the feasibility of EGBS as a bridge to or alternative to surgery when there are contraindications.
Methods:
We reviewed the cases of patients who underwent EGBS using a novel spiral-shaped plastic stent for acute calculus cholecystitis between January 2011 and December 2019. We retrospectively evaluated the long-term outcomes of EGBS using a novel spiral-shaped plastic stent.
Results:
Forty-nine patients were included. The clinical success rate of EGBS was 97%. After EGBS, 25 patients (surgery group) underwent elective cholecystectomy and 24 patients did not (follow-up group). In the surgery group, the median period from EGBS to surgery was 93 days. There was a single late adverse event with cholecystitis recurrence. In the follow-up group, the median follow-up period was 236 days. Late adverse events were observed in eight patients, including recurrence of cholecystitis (four patients), duodenal penetration by the distal stent end (two patients), and distal stent migration (two patient). In the follow-up group, the time to recurrence of biliary obstruction was 527 days.
Conclusions:
EGBS with a novel spiral-shaped plastic stent is safe and effective for long-term acute calculus cholecystitis. There is a possibility of EGBS to be a bridge to surgery and a surgical alternative for acute calculus cholecystitis in patients with contraindications to early cholecystectomy.
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